Intended and completed treatment pathways in non-metastatic oesophageal cancer treated with chemoradiotherapy: real-world survival and swallowing outcomes

In oesophageal cancer, the treatment pathway intended at the start of chemoradiotherapy is not always the pathway ultimately completed, particularly when surgery depends on post-treatment reassessment.We retrospectively reviewed consecutive patients with non-metastatic oesophageal or gastro-oesophageal junction cancer planned for curativeintent concurrent chemoradiotherapy at AIIMS Bathinda between August 2023 and August 2025.Patients were classified by initial treatment strategy as definitive chemoradiotherapy or planned trimodality treatment with subsequent surgical evaluation.Overall survival, treatment delivery, completed pathway, reasons for non-surgery, pathological response and swallowing outcomes were assessed, with follow-up updated to March 2026.Of 105 patients identified, 91 completed the planned radiotherapy course and were analysed.Seventeen (18.7%) were planned for definitive chemoradiotherapy and 74 (81.3%) for trimodality treatment.None of the definitive-chemoradiotherapy group underwent surgery.Among the 74 patients initially planned for trimodality treatment, 21 (28.4%)underwent surgery, and 53 (71.6%) did not; the most common reasons were failure to return after chemoradiotherapy (39.6%), disease progression or unresectability (22.6%), and declining surgery (18.9%).All 91 patients completed 50.4 Gy in 28 fractions, and 90 (98.9%) received concurrent chemotherapy, predominantly weekly paclitaxel-carboplatin.Pathological complete response (ypT0N0) was observed in 15 of 21 operated patients (71.4%).At data cut-off, 31 deaths had occurred; median follow-up among survivors was 12.6 months (IQR, 10.5-20.4),median overall survival was 23.5 months and 1-and 2-year overall survival were 72.5% and 48.0%, respectively.Among 60 surviving patients with evaluable swallowing outcomes, median dysphagia grade improved from 3 to 1, with 55 (91.7%) improving by at least one grade.Intended and completed treatment pathways frequently diverged in routine practice; reporting both provides a more meaningful context for interpreting real-world outcomes, without implying equivalence between surgical and non-surgical strategies.